Journal of the Formosan Medical Association最新文献

Background: Pregnant women with inflammatory bowel disease frequently experience suboptimal perinatal outcomes. One Taiwanese study conducted from 2001 to 2003 revealed higher risks of preterm birth and low birth weight in infants born to mothers with ulcerative colitis. With the advancement in disease management, we aim to investigate the pregnancy and perinatal outcomes of Taiwanese mothers with inflammatory bowel disease between 2004 and 2018.

Methods: We integrated data from Taiwan's Maternal and Child Health Database, Birth Reporting Database, National Health Insurance Database, and Catastrophic Illness Registry from 2004 to 2018. Mothers with inflammatory bowel disease were identified using International Classification of Diseases codes and the Catastrophic Illness Registry and matched 1:10 with healthy pregnant women based on the year of childbirth and maternal age. Statistical analyses involved chi-squared tests and conditional logistic regression models.

Results: A total of 3,059,647 births were recorded, of which 146 were born to mothers with IBD (126 to those with ulcerative colitis and 20 to those with Crohn's disease). We observed no significant differences in stillbirths, preterm births, cesarean deliveries, low birth weights, small- or large-for-gestational-age newborns, or Apgar scores between the mothers with inflammatory bowel disease and the controls. Hypertensive disorders of pregnancy were less prevalent in the inflammatory bowel disease group (4.1% vs 13.6%; P = 0.001). Subgroup analysis revealed consistent outcomes in both ulcerative colitis and Crohn's disease, across socioeconomic status, and disease duration.

Conclusions: Pregnancy and perinatal outcomes are comparable in Taiwanese women with inflammatory bowel disease and matched healthy counterparts. While no statistically significant differences were observed, the limited statistical power for certain outcomes warrants cautious interpretation. These findings highlight the need for further investigation in larger cohorts or pooled datasets to explore small but potentially clinically meaningful differences.

Background: Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (FL) is indicated after progression on gemcitabine-based therapy in patients with metastatic pancreatic ductal adenocarcinoma (PDAC). However, salvage therapy after nal-IRI/FL failure remains to be established.

Methods: This study included 260 consecutive patients who initiated nal-IRI/FL therapy reimbursed by the National Health Insurance of Taiwan between January 2019 and March 2023. All patients were stratified into three groups (adding-on, regimen-shifting, and supportive) according to their strategy for nal-IRI/FL treatment. The prognostic factors were identified using univariate and multivariate analyses. Propensity score matching (PSM) was used to compare the median overall survival (OS) between the adding-on oxaliplatin or nab-paclitaxel and regimen-shifting groups following treatment failure with nal-IRI/FL.

Results: The median OS after the initiation of nal-IRI/FL was 7.8 (95% confidence interval [CI], 5.2-10.5) months and 6.1 (95% CI, 5.3-6.9) months for the adding-on oxaliplatin or nab-paclitaxel and regimen-shifting groups, respectively (P = 0.035). An Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-1, no peritoneal metastasis before nal-IRI/FL, and the addition of oxaliplatin or nab-paclitaxel were significant independent prognostic factors for OS after nal-IRI/FL initiation. After PSM, the median OS after adding-on oxaliplatin/nab-paclitaxel or shifting regimens following the treatment failure of nal-IRI/FL were 4.1 (95% CI, 3.5-4.7) months and 3.1 (95% CI, 1.7-4.5) months, respectively (P = 0.039).

Conclusion: Addition of oxaliplatin or nab-paclitaxel to nal-IRI/FL was significantly associated with a better OS than regimen shifting after progression on nal-IRI/FL in patients with metastatic PDAC.

Background: Emphasis on primary health care (PHC) is the most efficient and economical approach to achieving universal health coverage, and should serve as its foundation. The aim of the study is to examine academic publications from 2011 to 2023 in the Asia-Pacific region (APR) using the Web of Science (WoS) subject category of PHC.

Methods: Academic papers in the WoS PHC category published in the APR from 2011 to 2023 were retrieved and analyzed, including papers published in the Science Citation Index-Expanded and the Social Science Citation Index.

Results: A total of 5172 papers were published in the WoS PHC category from APR onwards. The annual number of publications and their citations increased from 2011 to 2023. Australia led PHC publications in the APR with 3918 publications (75.75% of APR regional output). New Zealand had the highest number of citations per paper (14.54) and the highest mean impact factor (3.25 ± 1.70). Publications in the WoS PHC category also covered a wide range of topics, including Medicine General Internal (70.86%), Health Care Sciences Services (18.10%), Health Policy Services (17.67%), and Public Environmental Occupational Health (17.67%), demonstrating the breadth of PHC research.

Conclusion: The annual number of publications and their citations in the WoS PHC category from the APR increased from 2011 to 2023. Australia and New Zealand have a significant presence in the PHC publications in the APR.

Arterial hypertension is the most important modifiable risk factor for cardiovascular disease and a leading cause of death. The incidence of hypertension increases with age, with a lifetime risk of more than 90% for elderly individuals. With the growth in the absolute numbers and proportion of the elderly population worldwide, the economic impact and burden on healthcare systems due to elderly hypertension continue to rise. However, inconsistencies in the definition of elderly hypertension in different guidelines and the controversial results of various clinical trials underscore the importance of determining the consensus of management for elderly hypertension. Therefore, to clarify the current situation, this article discusses the definition, prevalence, and economic impacts of elderly hypertension.

Purpose: This study investigated whether Fibrosis-4 (FIB-4) score and its change can serve as predictors of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C (CHC) infection receiving direct-acting antivirals (DAAs).

Methods: This study identified 9679 patients who completed DAA treatment and achieved sustained virologic response (SVR) from the Taiwan Nationwide Real-World HCV Registry Program, and their risk of HCC was analyzed.

Results: Multivariable Cox regression analyses identified diabetes mellitus (DM), alpha-fetoprotein (AFP) level, and FIB-4 score as independent predictors of HCC in both Model 1 (baseline) and Model 2 (SVR). Change in FIB-4 score (△FIB-4) of < -0.9086 from baseline to SVR achievement was a significant predictor of HCC only in Model 2 (SVR). In Model 2 (SVR), DM (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.04-2.26, p = 0.033), FIB-4 score (≥3.25 vs. <3.25; HR: 2.40, 95% CI: 1.63-3.53, p < 0.001), △FIB-4 (greater reduction: <-0.9086 vs. smaller reduction: ≥-0.9086; HR: 1.85, 95% CI: 1.25-2.74, p = 0.002), and AFP level (≥20 vs. <20 ng/mL; HR: 16.40, 95% CI: 9.16-29.36, p < 0.001) were significant predictors of HCC. At 3 years, the cumulative HCC incidence was 10.67% in patients with an FIB-4 score of ≥3.25 upon achieving SVR and △FIB-4 of < -0.9086 and 1.72% in those with an FIB-4 score of <3.25 upon achieving SVR and △FIB-4 of ≥ -0.9086.

Conclusions: Posttreatment FIB-4 score and its change from baseline can be used to stratify HCC risk in patients with CHC receiving DAAs.

Background: Piriformis syndrome (PS) is a condition that causes low back pain. Ultrasound-guided injection (USI) has become a popular option for diagnostic block and treatment. Extracorporeal shockwave therapy (ESWT) is widely used for treating musculoskeletal diseases. However, few studies have compared the therapeutic efficacy of local steroid injections and ESWT.

Objectives: To compare the therapeutic efficacy of local corticosteroid injections and ESWT against PS.

Methods: This prospective randomized controlled trial enrolled 70 patients, who were randomly divided into two groups: the ESWT and USI groups. The ESWT group was subjected to one session of ESWT, and the USI group received one USI. Patients in both groups performed home-based stretching exercises. Evaluations were conducted at baseline and 1 and 5 weeks after the intervention. The outcomes included the patients' pain scores on a visual analog scale (VAS), Oswestry Disability Index (ODI), hip range of motion, side effects, and self-evaluation data.

Results: The groups did not vary significantly in terms of demographics. Significant time effects were observed in both groups, indicating post-treatment improvements. Furthermore, significant group effects were discovered in ODI and VAS pain scores. However, determining the superiority of one treatment over the other was challenging because of significant pretreatment differences between the groups in terms of ODI and VAS pain scores. However, no significant between-group difference was noted in the improvement rate.

Conclusions: ESWT and USI appear to be effective in the treatment of PS. The levels of efficacy of the two treatment approaches may be similar.

Clinical trial registration number: NCT04684537.

Background: To evaluate the correlation between atrial fibrillation (AF) burden and two-dimensional LA (left atrium) longitudinal reservoir strain (LARS) to explore the potential clinical utility of this novel parameter in patients with AF.

Methods: This cross-sectional study was conducted at the cardiac electrophysiology clinic of a tertiary centre by consecutively enrolling patients with non-valvular AF. The AF burden was evaluated using 14-day patch-based electrocardiography and defined as the percentage of time spent in AF during a 14-day monitoring period. High and low AF burdens were defined based on the median 14-day AF burden. Echocardiographic measurements, including the longitudinal strain of the LA, were performed in all patients.

Results: Among 267 patients, LARS was successfully performed in 221 (age 63 ± 11 years, male 71%, paroxysmal AF 71%). After adjusting for age, diabetes mellitus, congestive heart failure, estimated glomerular filtration rate, low-density lipoprotein level, left ventricular ejection fraction, LA dimension, and LA volume in multivariable linear regression analysis, low LARS remained a significant predictor of AF burden in addition to N-terminal pro-B-type natriuretic peptide and sex. Receiver operating curve analysis demonstrated that the best cut-off value for LARS to predict high AF burden (above median 10.49%) was 21.5%, with 75% sensitivity and 83% specificity.

Conclusions: LARS is associated with the AF burden in patients with AF. Further studies are needed to determine the role of routine LARS measurements in such patients.